Senile EBV-associated B-cell lymphoproliferative disorder of prepatellar bursa in an elderly patient with multifocal urate arthropathy

Epstein-Barr virus positive diffuse large B-cell lymphoma of the elderly

Epstein-Barr virus positive diffuse large B-cell lymphoma (EBV+ DLBCL) of the elderly is a rare B-cell lymphoproliferative disorder (B-LPD) that occurs in patients > 50 years with no known history of immunodeficiency or lymphoma. Patients present with moderate to severe clinical B-symptoms. These lesions show complete effacement of normal tissue/nodal architecture by large atypical lymphoid cells/immunoblasts and Hodgkin/Reed-Sternberg-like giant cells with variable amounts of inflammatory cells in the background. The ratio of neoplastic to inflammatory cells, degree of mitoses and necrosis can be quite variable; hence EBV+ DLBCL of the elderly was historically divided into low grade polymorphic and high grade monomorphic types. Further studies have shown both types to be different points in the spectrum of disease, and are all high grade lymphomas. The neoplastic large lymphoid cells show expression of CD20/CD79a and PAX-5, with variable expression of CD30, LMP-1 and EBNA-2, but CD15, CD10 and BCL6 are generally negative. Neoplastic cells show EBER positivity and high Ki-67 expression. Differential diagnoses include EBV+ B-LPD, classical Hodgkin lymphoma and EBV-DLBCL. EBV+ DLBCL of the elderly is highly aggressive with a median survival of 2 years. These patients are less responsive to standard chemotherapy compared with other B-LPD.

Epstein-Barr virus-positive B-cell lymphoma of the elderly at a United States tertiary medical center: an uncommon aggressive lymphoma with a nongerminal center B-cell phenotype

Epstein-Barr virus-positive B-cell lymphoproliferative disorders similar to those seen in posttransplantation patients have recently been described in immunocompetent, elderly Asian individuals. To our knowledge, this entity has not been described in the United States. The clinicopathologic features of 6 Epstein-Barr virus-positive B-cell lymphomas of the elderly from 5 patients 60 years and older were reviewed. Three specimens exhibited a polymorphous infiltrate with Reed-Sternberg-like cells. The remaining specimens resembled conventional diffuse large B-cell lymphoma. Most tumor cells were Epstein-Barr virus-positive by in situ hybridization and had a nongerminal center B-cell immunophenotype. In addition, 90 cases of diffuse large B-cell lymphoma in patients 60 years and older were screened for Epstein-Barr virus and were negative. All 5 patients were treated with combination chemotherapy; however, they had a poor outcome. Epstein-Barr virus-positive B-cell lymphomas of the elderly occur uncommonly at a United States tertiary medical center. Pathologic features that may aid in identification and trigger Epstein-Barr virus testing include a polymorphic infiltrate, plasmacytic morphology, Reed-Sternberg-like cells, angioinvasion, necrosis, and a nongerminal center B-cell immunophenotype. Further investigation is needed to determine if Epstein-Barr virus status plays an independent role in the prognosis of diffuse large B-cell lymphoma in non-Asian countries, which would also impact the need to screen all diffuse large B-cell lymphoma in older patients for Epstein-Barr virus.